Acute Exacerbation Impairs Right Ventricular Function in COPD Patients.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) may impair right ventricular (RV) function. Tissue Doppler imaging (TDI) is helpful in the noninvasive evaluation of RV longitudinal function. The aim of this study was to assess the impact of acute COPD exacerbation on RV function assessed by TDI. METHODS: The study included 30 COPD patients who had acute exacerbation and 30 controls. RV function was assessed echocardiographically during acute exacerbation and after recovery. In addition to conventional echocardiographic parameters, tricuspid annular plane systolic excursion, tricuspid annulus peak systolic velocity (Sa), and TDI-derived isovolumic myocardial acceleration (IVA) were determined. RESULTS: During exacerbation, COPD patients had a significantly larger RV and higher pulmonary artery systolic pressure, with significantly lower IVA, Sa and tricuspid annular plane systolic excursion compared to controls. After recovery, IVA and Sa significantly increased, while RV diameter and pulmonary artery systolic pressure significantly decreased to levels similar to controls. There were statistically significant, but modest correlations between IVA and Sa (r=0.441, p=0.003), tricuspid annular plane systolic excursion (r=0.628, p<0.001), pulmonary artery systolic pressure (r=-0.391, p=0.002) and RV diameter (r=-0.309, p=0.018). Sa correlated with pulmonary artery systolic pressure (r=-0.350, p=0.007) and RV diameter (r=-0.344, p=0.008). CONCLUSIONS: COPD exacerbations have a negative impact on RV function. TDI-derived IVA and Sa may be used in the assessment of subclinical RV dysfunction in COPD patients with exacerbation.

The acute effect of cardiac pacing mode on endothelial vasodilation: prospective, double-blind, cross-over, comparative clinical study.

BACKGROUND: Compared to atrioventricular sequential pacing, ventricular demand pacing is known to have somewhat more deleterious hemodynamic effects, which probably arise from increased sympathetic tonus and inappropriate baroreceptor activation. Endothelial function is affected by various local and systemic factors including baroreceptor activity. The aim of this study was to explore whether cardiac pacing would have any effect on endothelial functions. METHODS: Twelve patients (six male, mean age: 75 +/- 9 years) with previously implanted DDD or VDDcardiac pacemakers were included. All patients had stable atrial rhythms during the study. Patients were randomized to either atrial-based pacing mode (VDD or DDD) or ventricular demand pacing mode (VVI) first, and then cross-over was performed with the other pacing mode. Endothelial function was assessed by brachial artery ultrasonography. Basal diameter of the brachial artery, and both flow-mediated dilation (FMD) and endothelium-independent vasodilation with nitroglycerin were measured 1 hour after each pacing mode. RESULTS: Compared to atrial-based pacing mode, ventricular demand pacing was associated with a significantly worse FMD both as absolute and percentage values (0.17 +/- 0.09 mm vs 0.28 +/- 0.11 mm, P = 0.015 and 4.84 +/- 2.37 % vs 7.00 +/- 2.88 %, P = 0.028, respectively). However, there was no significant difference in nitroglycerin-mediated vasodilation values between the two pacing sessions. CONCLUSIONS: Acute ventricular demand pacing (VVI pacing) is clearly associated with attenuation of FMD in patients with atrial-based pacing systems. The attenuation of endothelial vasodilation might have a role in hemodynamic and clinical deterioration in patients with VVI pacemakers.

Inferior vena caval tumor thrombus extending into the right atrium in a patient with pancreatic cancer.

Venous thromboembolism is a common complication in patients with cancer and an important cause of morbidity and mortality. Idiopathic thrombosis, migratory or recurrent thrombophlebitis may be the first manifestation of an occult malignancy. While deep venous thrombosis and pulmonary embolism are the most common thrombotic conditions in patients with malignant disease, tumor thrombus may be seen in inferior vena cava, mainly in patients with renal cell carcinoma, hepatocellular carcinoma, testicular tumors or adrenal carcinoma. Although pancreatic cancer is one of the cancers that are most strongly associated with thrombotic complications along with cancers of ovary and brain, there has been no report about presence of thrombus in the inferior vena cava in pancreatic cancer. We report a female patient with pancreatic cancer associated with tumor thrombus extending from the inferior vena cava to the right atrium.